Simultaneous Vascularized Lymph Node Transfer and Breast Reconstruction: A Systematic Review

Background/Objectives: Simultaneous vascularized lymph node transfer (VLNT) and breast reconstruction is a reconstructive option that potentially addresses two adverse consequences of breast cancer treatment in the same operation. This systematic review aims to analyze the quality of data and outcomes in the current literature. Methods: This systematic review was performed following PRISMA guidelines. A systematic search was conducted with Google Scholar and PubMed for studies with the simultaneous intervention of VLNT and breast reconstruction. The search terms were ((diep OR pap OR expander OR implant OR breast OR msTRAM OR TRAM) AND ("vascularized lymph node")). Studies were included if they were original articles that discussed patients who underwent simultaneous VLNT and breast reconstruction. Additional sources were identified from bibliographies. Patient characteristics, types of treatment, reconstruction, and outcome measures were collected. This review was not registered. Results: A total of 1969 unique English literature search results led to the inclusion of 118 studies. Further analysis was performed on 42 non-review articles, documenting a total of 772 patients. The mean patient age was 51.6 years, the mean BMI was 28, and there was a mean follow-up of 23.8 months. Discrete breast reconstruction data were given for 494 patients with 492 autologous reconstructions and 2 tissue expander-to-implant reconstructions. The most common reconstructive approach was a deep inferior epigastric flap. The most common VLNT donor site was the superficial inferior epigastric nodes, followed by superficial circumflex iliac nodes. Indications for 646 patients were for treatment and 18 were for prevention, while 108 were not specified. The mean excess volume reduction in treatment studies was 39.5%. A total of 168 complications (21.8%) were reported, with donor site seromas being the most common. Additionally, four partial and three total flap failures were reported. Conclusions: VLNT can be safely combined with autologous breast reconstruction for the treatment or prevention of breast cancer-related lymphedema. Future research should standardize the approach for data collection and report patient outcomes for lymphedema and immediate lymphatic reconstruction.